Misdiagnosis? (A question for practitioners)

**Posts:** 1 · by **TinyD26** » Fri Oct 03, 2014 10:23 pm

Hello. I've been in and out of therapy since I was about 13. The only actual clinical diagnosis I've ever received are of depression and some nebulous form(/s) of anxiety disorder (GAD/Social?)

Now and then I've had therapists bring up the possibility of other disorders, namely ADD/ADHD. However, no one has ever given me that diagnosis I think mainly because they didn't feel that I'm impulsive enough, and because as far as I can remember, I didn't show symptoms as a child. However, I'm not positive that the symptoms weren't there- I just don't remember..

I've also had other people in my life hint at the possibility of bipolar or other disorders.

The older I get, the more clearer the severity of some of my "issues" becomes. And there are a lot of them: depression, anxiety, neurosis, co-dependency, self image/ self worth issues/ insecurity, compulsive eating, trouble focusing.....

The more I read (I'm sure you love to hear that), the more I feel like I fit the criteria for some of these disorders. Most strikingly, BPD. However, when asked about some of these sympotms, and when reading and assessing how well I fit the criteria, it's very difficult to know/ to know how to answer, because I don't know what's normal. With BPD, for instance, the descriptions I've read fit me pretty darned well, except for the emphasis on impulsivity. I think I'm somewhat impulsive at times- and yes, particularly when stressed. But I've never done anything overtly dangerous like driven extremely recklessly, and I've never just up and gotten on a plane and left my job and pets behind and not told anyone where I was going, etc. (this is an example one of my therapists used when questioning me about impulsivity). And at other times, I'm far too anxious and neurotic to be impulsive, and I actually feel like a real stick in the mud.

Do you have any thoughts on this or suggestions on how to express these things in a way that will allow a therapist to gauge my behaviors appropriately?

Thanks.

**Posts:** 954 · by **Beloved** » Wed Oct 08, 2014 8:17 pm

Look up your stuff in DSM-V.

It'll put the next therapist on notice that you have done some research. And see if you can get on NIH online, they may help.

**Posts:** 4 · by **hypnocbt** » Thu Oct 16, 2014 5:15 pm

Hi

Do you want to get the "correct" diagnosis? Or do you want to have someone help you figure out what needs to change for things to be better for you?

Diagnostic labels are deeply problematic... the best they do is provide some guidance for a treatment plan.

However there are approaches that are "transdiagnostic" - i.e. the therapist doesn't need those diagnostic categories.

Some of these approaches are very practical - they are often simple and remarkably effective with a strong evidence-base. Try looking into:
Problem Solving Therapy
Stress Inoculation Training (aka Coping Skills Training)
Acceptance & Commitment Therapy (ACT)

These approaches tend to focus on making behavioural change about practical issues without enquiring into the whole psychiatric diagnostic categories. They can be effective in for quite severe and complex cases. (They also help to "uncomplicate things" - so we end up with a much more practical focus on issues rather than having more labels that simply add surplus concepts to the problems we are having).

Hope that's helpful!

Mark

**Posts:** 954 · by **Beloved** » Thu Oct 16, 2014 7:25 pm

hypnocbt wrote:Do you want to get the "correct" diagnosis? Or do you want to have someone help you figure out what needs to change for things to be better for you?
#1

having more labels that simply add surplus concepts to the problems we are having).
#2

#1 False dichotomy.

#2 A label is an abstraction or a summary rather than another concept.

**Posts:** 4 · by **hypnocbt** » Fri Oct 17, 2014 8:43 am

Beloved wrote:
hypnocbt wrote:Do you want to get the "correct" diagnosis? Or do you want to have someone help you figure out what needs to change for things to be better for you?
#1

having more labels that simply add surplus concepts to the problems we are having).
#2

#1 False dichotomy.

#2 A label is an abstraction or a summary rather than another concept.

How is 1/ a false dichotomy?
Diagnostic labels are not therapy/treatment plans (what needs to change for things to get better).
e.g. compare a diagnosis of ADHD with e.g. stress inoculation training for impulsive children. One is a diagnostic label that doesn't tell you what treatment plan to follow... meditations? Neurofeedback? Behavioural skills training?
Whereas SIT is very specific in having clients learn and deploy coping skills in specific stressful situations. It doesn't need to know how some professional categorised what is happening. It takes a highly pragmatic, functional approach.
Diagnostic categories do not provide for treatment plans. For that one has to look at the evidence-base.

2/ Diagnostic labels are concepts. They attempt to summarise but remain concepts (abstractions) - i.e. they not facts.
The issue is that clients can end up ruminating more (core process in depression) or worrying more (core process in GAD) about these ideas - as if they are facts. They are not. Taking ideas as facts is again a core mechanism in psychopathology.

These (manmade) ideas (which can be very useful in guiding treatment) - can become an issue in complex cases and cause both therapist and client to attend to a series of concepts rather than the client's experience.

To come back to the OP.
Gaining a series of labels for your condition might help in getting insurance coverage - it doesn't necessarily guide treatment plans - especially where there is co-morbidity (i.e. you meet several diagnostic criteria).

If your head is spinning with those diagnostic categories and needing to know which you have, then you may find it very refreshing and liberating to work with a therapist trained in transdiagnostic approaches.

Also research is backing that up - I can't post a link but go to PubMed and this document: pubmed/23212696
Effect of transdiagnostic cbt for anxiety disorders on comorbid diagnoses.
"These results suggest that transdiagnostic cognitive-behavioral group treatment for anxiety may be associated with greater decreases in comorbidity than traditional diagnosis-specific CBT."

**Posts:** 954 · by **Beloved** » Fri Oct 17, 2014 11:13 am

Look up logical fallacies and cognitive biases.
Decide how many of these 200 or so you are falling victim to.
Report back.

**Posts:** 4 · by **hypnocbt** » Mon Oct 20, 2014 9:34 am

Hmmm - have to say I don't find your communication style very engaging. It comes across as quite demeaning. You seem to like to shoot down ideas and suggestions in an unhelpful and frankly ungracious way.

Isn't it a reasonable hypothesis that the client and the therapist are getting caught in diagnostic criteria and labelling? This is particularly a problem with co-morbidity.

**Posts:** 954 · by **Beloved** » Mon Oct 20, 2014 11:45 am

hypnocbt wrote:Hmmm - have to say I don't find your communication style very engaging. It comes across as quite demeaning. You seem to like to shoot down ideas and suggestions in an unhelpful and frankly ungracious way.

I like to think I give what I get.

Misdiagnosis? (A question for practitioners)

#1

#2

#3

#4

#5

#6

#7

Main Menu

Therapy Practitioner Resources

Recent posts

Active topics

Contact Us